This randomized controlled trial aims to evaluate and compare the effectiveness of combined contrast therapy with intermittent compression and whirlpool therapy in patients with post-traumatic CRPS-I of the hand and wrist, using objective outcome measures of pain, edema, and functional status.
Complex Regional Pain Syndrome Type 1 (CRPS-I) is a condition that may develop after upper extremity trauma, surgical interventions, or central nervous system disorders, leading to chronic pain and functional impairment. Hydrotherapy modalities such as whirlpool and contrast bath therapy are commonly used; however, comparative evidence with combined thermal and compression-based systems remains limited. Combined contrast therapy with intermittent compression is a non-invasive intervention delivered using the Game Ready MED4 Elite device, which integrates thermal therapy (cold-warm) with intermittent pneumatic compression (IPC). Evidence, particularly from postoperative orthopedic settings, suggests that this approach may reduce pain and edema and promote functional recovery. Cryotherapy reduces inflammation and vascular permeability, thermotherapy promotes vasodilation and tissue relaxation, and intermittent pneumatic compression (IPC) enhances venous and lymphatic return, supporting regional circulation. The whirlpool method is a commonly used adjunctive physical therapy modality in CRPS-I treatment, involving immersion of the affected extremity in circulating water at 38-40°C. This technique provides both thermal and mechanical stimulation, promoting regional circulation, reducing muscle spasm, and facilitating edema drainage. Additionally, the gentle massaging effect of water turbulence may contribute to pain modulation and tissue relaxation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
50
This non-invasive intervention will be delivered using the Game Ready MED4 Elite device, which integrates thermal therapy (hot-cold) with intermittent pneumatic compression (IPC). The device is capable of simultaneously providing contrast therapy and intermittent pneumatic compression and is widely used in upper and lower extremity rehabilitation. Rapid Contrast Therapy Protocol: Heat application: Applied at 39 °C for 3 minutes Cold application: Applied at 15 °C for 1 minute, with mild compression during the cold phase Cycle duration: The heat-cold cycle will be repeated continuously for a total of 15 minutes
Whirlpool therapy is a hydrotherapy modality used to enhance circulation in the upper extremity, reduce muscle spasm, alleviate pain, and facilitate edema resolution. In this study, a Technomex® whirlpool device will be used for hydrotherapy applications. The water temperature will be set at 40 °C and continuously monitored with a thermometer. The device motor will generate a circular turbulent water flow. The patient's hand and wrist will be positioned comfortably in the tank without compromising circulation. The duration of each session will be 15 minutes.
Etlik City Hospital, Department of Physical Medicine and Rehabilitation
Ankara, Yenimahalle, Turkey (Türkiye)
RECRUITINGVisual Analog Scale (VAS)
Patients rate their pain on a 0-10 scale. A lower score indicates reduced pain.
Time frame: At baseline, at 3 weeks (end of treatment), and at 7 weeks (follow-up).
Hand Function (QuickDASH)
The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire is a brief and practical tool used to assess upper extremity functional status and its impact on daily activities. It is the short form of the original DASH questionnaire and consists of 11 items. Participants rate their difficulty in performing daily activities involving the arm, shoulder, and hand using a 5-point Likert scale. Scores are standardized on a 0-100 scale, where 0 indicates no disability and 100 indicates the highest level of disability.
Time frame: At baseline, at 3 weeks (end of treatment), and at 7 weeks (follow-up).
Neuropathic Pain Assessment (LANSS)
Neuropathic pain will be evaluated using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale. This tool assesses pain characteristics and sensory dysfunction through a combination of patient-reported symptoms and clinical examination findings. The total score ranges from 0 to 24, with scores ≥12 suggesting the presence of neuropathic pain.
Time frame: at baseline, at 3 weeks (end of treatment), and at 7 weeks (follow-up)
Edema Measurement (Circumferential Measurement)
Edema will be assessed using circumferential measurements with a measuring tape at the wrist and palm. Wrist circumference will be measured just proximal to the distal radioulnar joint, and palm circumference will be measured at the widest level across the metacarpal heads. Measurements will be performed with the patient in a relaxed sitting or standing position, with the hand and wrist in a neutral position and the limb supported to avoid muscle contraction. The tape will be applied gently without compression. Two to three measurements will be taken at each site, and the average value will be recorded.
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Time frame: at baseline, at 3 weeks (end of treatment), and at 7 weeks (follow-up)
Range of Motion (ROM) and Finger-to-Palm Crease Distance (FT-PCD)
Wrist range of motion will be assessed by measuring wrist flexion and extension using a standard hand goniometer. The patient will be positioned in sitting with the shoulder in neutral position, the elbow at 90° flexion, the forearm in neutral rotation, and the wrist in a neutral position. Each movement will be measured 2-3 times, and the average value will be recorded.
Time frame: At baseline, at 3 weeks (end of treatment), and at 7 weeks (follow-up)
Hand Grip Strength (HGS)
Hand grip strength will be measured using a Jamar hand dynamometer (Jamar, USA) in accordance with the standardized position recommended by the American Society of Hand Therapists. Participants will be seated with the shoulder in adduction and neutral rotation, the elbow at 90° flexion, the forearm in neutral position, and the wrist in a neutral position. Three measurements will be performed for each participant with a 1-minute rest interval between trials, and the average value will be recorded. Grip strength will be expressed in kilograms-force (kgf).
Time frame: at baseline, at 3 weeks (end of treatment), and at 7 weeks (follow-up)
Finger-to-Palm Crease Distance (FT-PCD)
Finger-to-palm crease distance (FT-PCD) will be measured in centimeters as the distance between the tip of the third finger and the distal palmar crease. This measurement will be used to quantitatively assess limitations in finger flexion associated with edema and joint stiffness.
Time frame: At baseline, at 3 weeks (end of treatment), and at 7 weeks (follow-up)